Any Medicaid cuts are bad for kids. Medicaid, or Medi-Cal as it’s known in California, covers over half of California’s kids and provides comprehensive benefits for children. New research confirms that Medicaid is even more important for the health of rural kids. In California’s small towns and rural areas, 54% of children are covered by Medi-Cal, compared to 44% of kids in metro areas.

The BCRA gets an “F” for protecting Medicaid. The bill would dramatically restructure Medicaid financing (PDF) by capping federal funds going to the program. This essentially shifts huge costs to the states to maintain coverage and care. California’s Department of Health Care Services estimates that the BCRA would shift more than $114 billion in costs to California between 2020 and 2027.

School Medi-Cal Services Put at Risk

The BCRA would also shift the costs of providing school-based health services and special education services, which Medicaid now pays for, to school districts and the state. School districts rely on Medicaid to cover the costs for special education services (such as physical therapy) and equipment (like feeding tubes) to serve low-income students and those with disabilities. Without this support, schools will struggle to provide high-quality services them and will have great difficulty complying with federal mandates associated with the Individuals with Disabilities Education Act (IDEA). Medicaid also is an important source of coverage for preventive care, such as vision and hearing screenings and immunizations, for other Medicaid-eligible children. Losing Medicaid-supported services in school will hurt children and disrupt students’ learning opportunities.

BCRA supporters misleadingly claim to provide “protection” for some children who are determined to have a disability. The bill proposes to exempt them from the Medicaid per-capita cap. Unfortunately this means very little when the base program providing that coverage is stripped of funding at the scale proposed by the BCRA. And in California, if a Medicaid cap would be bad for the 180,000 “medically complex” children with Medi-Cal, then why would it not also be risky for the other 5.6 million California children who get their health care through Medicaid?

The BCRA would also undermine the private health insurance markets used by California families and businesses to purchase coverage. The bill would repeal the Affordable Care Act’s health insurance premium tax credits and cost-sharing reductions and replace them with less generous subsidies to fewer families. This risks destabilizing the Covered California marketplace, which covers 77,000 kids and nearly 1.4 million adults.

Mike Odeh is the director of health policy at Children Now, California’s leading children’s advocacy organization. Mike has been supporting Children Now’s health policy efforts for more than seven years, where his focus has primarily been on health coverage, Medi-Cal financing, access, quality, and healthy child development. Mike previously worked at the Georgetown University Health Policy Institute Center for Children and Families and at Health Access California. A native of southern California, Mike earned a master of public policy degree from Georgetown University after graduating from Creighton University in Omaha, Nebraska.